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- Bergh, Niklas, 1979, et al.
(författare)
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Estimating the clinical and budgetary impact of using angiotensin receptor neprilysin inhibitor as first line therapy in patients with HFrEF.
- 2024
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Ingår i: ESC Heart Failure. - 2055-5822. ; 11:2, s. 1153-1162
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Tidskriftsartikel (refereegranskat)abstract
- Recent updates of international treatment guidelines for heart failure with reduced ejection fraction (HFrEF) differ regarding the use of angiotensin receptor neprilysin inhibitor (ARNI) as first-line treatment. The American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) 2022 guidelines gives ARNI a Class IA recommendation for HFrEF patients while the European Society of Cardiology's guidelines are less clear when ARNI could be considered as first line treatment option in de novo patients. This study aimed to model the clinical and budgetary outcomes of implementing these guidelines, comparing conservative ARNI prescription patterns with less conservative in Sweden and in the United Kingdom.A health economic model was developed to compare different treatment patterns for HFrEF. Incident cohorts were included on an annual basis and followed over 10years. The model included treatment specific all-cause mortality and hospitalization rates, as well as drug acquisition, monitoring, and hospitalization costs. Increasing the use of ARNI could lead to about 7000-12300 life years gained and 2600-4600 hospitalizations prevented in Sweden. These health benefits come with an additional cost of 112-195 million euros. Similar results were estimated for the United Kingdom, albeit on a larger population.Increasing the proportion of patients receiving ARNI instead of angiotensin converting enzyme inhibitors as first-line treatment of HFrEF will lead to a considerable number of additional life years gained and prevented hospitalizations but with additional cost in terms of health care expenditure in Sweden and in the United Kingdom.
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| 2. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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Estimating the Causal Impact of Macroeconomic Conditions on Income-Related Mortality
- 2020
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- To-date the macroeconomic conditions-mortality literature on income-related inequality in mortality has relied on subgroup analysis, mainly using income as a stratification variable, but this nearly always causes selection bias yielding results that are hard to interpret. To solve this bad control problem, we apply a novel technique based on recentered influence function regression of overall income-related mortality measures, like the commonly used concentration index. We also highlight the importance of: i) measurement of relative versus absolute inequality; ii) measurement of inequality by population-level statistics of inequality (concentration indices) versus subgroup analysis; iii) measurement of short versus long-term income. We illustrate these issues and our suggested solution using detailed individual-level administrative data from Sweden. Our findings show that there overall is a (insignificant) counter-cyclical impact on mortality and its income-related inequality. During a sub-period of pronounced and significant counter-cyclical mortality we find support for accompanying counter-cyclical income-related inequality, but only when using short-term income.
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| 3. |
- van den Berg, Gerard, et al.
(författare)
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Mortality and the Business Cycle : Evidence from Individual and Aggregated Data
- 2017
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Ingår i: Journal of Health Economics. - : Elsevier BV. - 0167-6296 .- 1879-1646. ; 56, s. 61-70
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- There has been much interest recently in the relationship between economic conditions and mortality, with some studies showing that mortality is pro-cyclical, while others find the opposite. Some suggest that the aggregation level of analysis (e.g. individual vs. regional) matters. We use both individual and aggregated data on a sample of 20-64 year-old Swedish men from 1993 to 2007. Our results show that the association between the business cycle and mortality does not depend on the level of analysis: the sign and magnitude of the parameter estimates are similar at the individual level and the aggregate (county) level; both showing pro-cyclical mortality.
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